Health Reform Bill Could Include Cost of Dispensing Study

By Kevin Schweers

Senator Michael Bennet (D-CO) today filed an amendment to the health care reform bill that would require the Government Accountability Office to conduct a Medicaid cost of dispensing survey. It’s been more than a decade since the feds last examined this issue in detail. Since that previous study there have been a variety of federal and state pushes to cut pharmacy reimbursement again and again without government data to fully know the impact of such reductions.

NCPA strongly supports such a study. Right now Congress is in the midst of determining the fix it will apply to the court-delayed, average manufacturer price based reimbursement. If reimbursements are set too low they would force many community pharmacies out of the Medicaid program or to close altogether. While NCPA believes the current Senate language of “no less than 175%” is preferable to the lower House level, it still may not be sufficient to recover from low state dispensing fees.

NCPA wrote to Sen. Bennet thanking him for requesting the study.  Excerpts of that letter follow below. We’re urging all Senators to support the amendment:

“We strongly support passage of your provision requiring the GAO to conduct a state-specific Medicaid pharmacy cost of dispensing study as part of health care reform. This study can help determine the true costs to pharmacies to provide needed Medicaid prescription drugs and pharmacy services to their patients.

“It is important for GAO to study and determine an appropriate level of state-specific dispensing fees under Medicaid because there is a significant discrepancy between average state dispensing fees and recent measures of the actual cost to dispense. For example, the 2009 NCPA Digest [sponsored by Cardinal Health] found that the cost of dispensing in 2008 was $11.01 per prescription. Similarly, the 2007 Grant Thorton study found that figure to be $10.50 in 2006. In contrast, the aggregate average dispensing fee paid by the states under Medicaid has been estimated to be between $4.75 and $5.02 per prescription.

“The proposed study is particularly important for rural states like Colorado, where a pharmacy may be the only accessible health care provider for many miles. In fact, over half of all pharmacies that serve rural areas of America are independent pharmacies. We appreciate your recognition of the importance of rural pharmacies to the nation’s health care infrastructure. A GAO study could give Congress and the States needed information by which to measure the adequacy of the dispensing fees they pay and the impact upon patient access to pharmacy services. We appreciate your leadership on this issue and look forward to working with you on this important study.”

1 Response to “Health Reform Bill Could Include Cost of Dispensing Study”

  1. 1 More Changes Possible to Senate Health Reform Bill « Trackback on December 8, 2009 at 7:29 pm

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